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General NPI Number Information
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NPI Number | 1508199829
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Entity Type | Individual
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Provider Name | GREGORY GEORGE YOUNT DMD
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Gender | Male
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Dates
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Enumeration Date | 09/18/2009
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Last Update Date | 09/18/2009
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Provider Practice Location Address
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Address Line | 225 RICHMOND AVE E
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City | MATTOON
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State | IL
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Zip | 61938-4651
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Country | US
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Telephone | 217-235-0435
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Fax | 217-234-3418
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Provider Business Mailing Address
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Address Line | PO BOX 1217
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City | MATTOON
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State | IL
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Zip | 61938-1217
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Country | US
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Telephone | 217-235-0434
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Fax | 217-234-3418
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019.020918
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License Number State | IL
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